Christopher Snowdon: The WHO’s war on e-cigarettes proves it has no interest in an evidence-based approach to tobacco harm reduction

18 Jun

Christopher Snowdon is Head of Lifestyle Economics at the Institute of Economic Affairs. He is the author of A safer bet: Gambling and the risks of over-regulation, published this week.

The World Health Organisation’s decision last month to give a special award to India for banning the sale of e-cigarettes was proof that the agency has no intention of taking an ethical and evidence-based approach to tobacco harm reduction. This puts it squarely at odds with countries such as the UK and New Zealand which have successfully embraced vaping as part of their tobacco control strategy.

In November, the WHO will hold its ninth Framework Convention on Tobacco Control Conference of the Parties (COP9). The Framework Convention on Tobacco Control (FCTC) is the first and, to date, only international treaty of the World Health Organisation. Adopted in 2003 and signed by 168 countries, it explicitly defines tobacco control as “a range of supply, demand and harm reduction strategies”. Unfortunately, harm reduction is unlikely to feature much at the conference, except as an object of derision and contempt.

The WHO has never pursued harm reduction policies in relation to smoking and in recent years has increasingly worked to stamp out e-cigarettes and other reduced risk nicotine products. It does not discourage member states from banning them outright and it encourages those who had not banned their sale to prohibit or restrict e-cigarette advertising, tax e-cigarettes “at a level that makes the devices and e-liquids unaffordable to minors”, ban or restrict flavours “that appeal to minors”, and ban vaping indoors wherever smoking was banned.

There is no doubt that e-cigarettes are much, much safer than combustible cigarettes. Public Health England and the Royal College of Physicians have both stated that the risks of vaping are likely to be at least 95 per cent lower than the risks of smoking. The US National Academies of Science Engineering and Mathematics concluded, after a thorough review of the evidence, that “e-cigarettes are likely to be far less harmful than combustible tobacco cigarettes”. After more than a decade on the market, with millions of regular users, no deaths have been associated with regulated e-cigarettes.

Despite an ever-expanding body of evidence confirming that e-cigarettes are much less hazardous than combustible tobacco and are more effective than nicotine replacement therapy in helping smokers quit, the WHO has doubled down on its hostility even as real world evidence continues to show smoking rates declining as vaping rates increase.

In January 2020, as Covid-19 spread around the globe, the WHO put out a series of bizarre Tweets about vaping, falsely claiming that e-cigarette liquid burns skin and that secondhand vapour harms bystanders. One Tweet even suggested that e-cigarettes could be “more dangerous than regular cigarettes”. In December 2020, WHO Europe described e-cigarettes and other reduced-risk products as “the next frontier in the global tobacco epidemic” and said that “with rigorous implementation of the WHO FCTC, a path can be built towards a tobacco and nicotine-free future.” A nicotine-free future clearly leaves no room for e-cigarettes.

The WHO’s handling of COVID-19 has tarnished its reputation in the last 18 months, but it is still respected by many people who associate it with the successful campaign to eradicate smallpox in the 20th century. If the WHO says that e-cigarettes are a dangerous product that threaten to derail decades of progress in the fight against smoking, many people will take it on trust. Many countries do not have the resources to carry out the kind of evidence reviews conducted in the UK and the USA. Instead, they rely on agencies such as the WHO and the FCTC, little knowing that they have been captured by a small group of abstinence-only prohibitionists.

As I argue in a new report, the FCTC Secretariat and the COP meetings are not fit for purpose. In their relentless opposition to vaping and other reduced risk nicotine products, they have become a threat to global health. How should vapers and enlightened public health advocates respond? COP meetings are notoriously secretive. Journalists and the public are technically allowed in as observers under strict conditions (e.g. they must have no conceivable connection to the tobacco industry), but are invariably thrown out on the first day (without a vote being held). In 2014, Drew Johnson of The Washington Times was forcibly ejected from the venue in Moscow after being told that “the media is banned”. In 2018, the internet livestream was cut off early in proceedings. This lack of transparency is unacceptable for a UN conference funded by taxpayers.

But there is a phrase in medical ethics that is relevant to this debate: “Nothing about me without me”. Vapers have little chance of being even being allowed to view COP9 online, let alone being permitted to speak at it. Their only hope is to contact their elected representatives and demand that pressure be put on the FCTC to take a more open and evidence-based approach. COP meetings fly under the media’s radar and that is how the FCTC Secretariat likes it. It thrives in darkness.

Journalists should ask more questions about what goes on in these meetings. Governments which recognise vaping’s potential to lower smoking rates and save lives should make that case strongly at COP9. They should pick strong, articulate advocates as their delegates, not bureaucrats. If the WHO continues to spread misinformation about e-cigarettes and if COP9 is held in secret again, these governments should withdraw their funding of the FCTC Secretariat. The FCTC Secretariat should be put on notice. COP9 is the last chance for the WHO FCTC to mend its ways and operate as a transparent and evidence-based organisation. If it cannot be reformed, it should be disbanded.

Christopher Snowdon: To reduce problem gambling effectively, use targeted measures – not blanket bans

11 Mar

Christopher Snowdon is Head of Lifestyle Economics at the Institute of Economic Affairs. He is the author of A safer bet: Gambling and the risks of over-regulation, published this week.

The Government launched a public consultation on gambling regulation in December, saying that it wanted to make Britain’s gambling laws ‘fit for the digital age’.

Now that fixed-odds betting terminals have been banished from bookmakers, online gambling has become the main target of anti-gambling activists. They have a wish list of things they want banned, including gambling advertising and sponsorship, VIP schemes and high stake games. Some have even suggested a legal limit on how much gamblers can spend each month.

These prohibitions are designed to tackle Britain’s supposed gambling epidemic, and yet a close look at the data shows that there has been no rise in the number of people gambling in the UK in recent years, and the amount spent on gambling was in decline even before the pandemic.

Fewer children are gambling than a decade ago and, whilst there is no doubt that pathological gambling can have serious consequences, rates of problem gambling have not risen in twenty years. At around 0.6 per cent of the adult population, our problem gambling rate is lower than in many countries which have stiffer regulation, and it is notable that the number of problem gamblers has not risen despite the growth of online gambling and the proliferation of gambling advertising.

The existence of problem gambling should not be used as an excuse for an endless crusade against an activity which provides harmless fun to the majority of consumers. A mental health problem that affects a small minority requires a targeted response. The NHS has opened a number of problem gambling clinics in recent years, and more are due to open by 2023/24. Offering help to those who need it is a far more constructive and effective approach than hitting all gamblers with bans and restrictions.

The measures proposed by some activists, such as slowing down games and limiting prize money, are not so much designed to help problem gamblers as deter anyone from gambling by sucking the fun out of it. That is not what regulation is supposed to do, and it carries risks of its own.

To operate and advertise in the UK, gambling companies have to abide by UK regulation and pay tax to the British government. Most gamblers are happy to use licensed websites, but that could change if games are made tedious and unexciting by over-zealous politicians. Recent research found that 4.5 per cent of UK online gamblers had used an unlicensed operator in the past twelve months, and 44 per cent were aware of at least one unlicensed gambling website. If the government makes the regulated sector less appealing, demand for the unregulated sector is likely to grow. The Government will get less tax revenue and punters will get less protection.

A smarter approach would be to use technology to our advantage. In the past, gambling companies often didn’t know who their customers were. Today, they not only know their customer’s name and address (which they cross-check with credit agency databases), but how much they spend, what they play and how they play. They know if a person has self-excluded from any other regulated website.

The ability of ‘Big Data’ to identify problem gamblers and prevent harm is unlike anything we have seen before. Players can set deposit limits, set playing times and opt out of receiving inducements, such as free bets. Algorithms are used to identify ‘markers of harm’, such as chasing losses, switching between products and playing late at night.

These red flags trigger interventions. A gambler who displays unusual behaviour might receive an e-mail reminding them about deposit limits, or be taken off mailing lists offering bonuses and inducements. Those deemed to be at higher risk will receive a phone call or be given a spending cap or have their account suspended, sometimes permanently.

Regulated online operators have a range of practical harm reduction measures available to them which target problem gamblers without infringing the rights of the average punter. Not every company uses their technology to prevent harm in the same way, but they could. Best practice could be made standard. It is these practical, sophisticated solutions, not the blunderbuss approach of anti-gambling activists, that should be the focus of the Government’s review.